Tasha Hedges used Xanax for two decades to manage her anxiety and panic attacks, following her psychiatrist’s recommendations. However, in 2022, her doctor passed away unexpectedly.
Although the general practitioner continued the prescription, he retired shortly thereafter. The next physician moved to Canada, leaving Hedges to eventually find another psychiatrist.
“The first thing he did was yell at me for being on Xanax for too long,” she recounted from W.Va.
Typically, discontinuing the medication requires a gradual reduction of dosage over several months or years, referred to as tapering. However, Hedges stopped abruptly, facing severe withdrawal symptoms such as hot flashes, cold sweats, restlessness, shaking, and teeth grinding.
“It was a nightmare,” she described. Two years after ceasing the medication, she still grapples with repercussions. “My brain wasn’t the same.”
Online support groups and platforms like Benzobuddies indicate that individuals like Hedges are physically dependent on benzodiazepines. Many encounter serious and potentially dangerous withdrawal symptoms when their medication is abruptly ceased or tapered too quickly, leading to extended periods without treatment. Some healthcare providers hesitate to prescribe these medications due to associated risks and stigma.
“They’re often seen as highly addictive,” noted Ronald M. Winchell, a clinical psychiatry professor at Columbia University, who posed several questions to consider: “Would I initiate this treatment? Is it appropriate? Is it safe? Could my patients misuse it? What do my peers think?”
Prescriptions for benzodiazepines such as Xanax, Ativan, and Klonopin have declined since 2016 due to provider concerns. Nonetheless, these medications remain quick and effective solutions, often being among the most prescribed in the country for anxiety and sleep disorders. In 2019, around 92 million benzodiazepine prescriptions were issued in the U.S., according to the Food and Drug Administration.
Current guidelines advise prescribers to use the lowest effective dose for the shortest duration, typically less than four weeks. However, many patients remain on these medications for longer periods. An FDA review in 2018 indicated that approximately half of patients had used the drugs for over two months. Dr. Edward K. Silverman, a professor emeritus of psychiatry at Tufts University School of Medicine, highlighted that some patients stay on these medications without regular consultations.
Patients can develop physical dependence within weeks of stable benzodiazepine use. Stopping the medication, even after a brief period, necessitates a carefully managed process. Unfortunately, many healthcare providers lack adequate training in tapering prescriptions. To clarify the process, an expert from the American Society of Addiction Medicine released new guidelines in March for dosage reduction developed with FDA funding.
“It’s absolutely reckless to force people into rapid tapering,” Dr. Silverman stated.
Jodie Jerlow, 60, began using Klonopin for insomnia 25 years ago while in Dallas. After her psychiatrist retired for health reasons, she found another doctor who recommended two additional benzodiazepines, Xanax and Ativan, while working towards withdrawing from Klonopin.
After about six months on all three medications, Jerlow grew frustrated and decided to take matters into her own hands. She successfully tapered off Klonopin and Xanax.
She is still working to discontinue Ativan with assistance from her general practitioner and a coach at the nonprofit Benzodiazepine Information Coalition.
Initially, Jerlow noted she tapered too quickly, experiencing headaches, nausea, and agoraphobia. However, one of the most distressing withdrawal symptoms was suicidal ideation.
“It felt like background noise. ‘It’s going to be easy,’” she recalled.
These were feelings she had never encountered before reducing her medication.
In 2023, advocates for those harmed by benzodiazepines reported various long-term symptoms that may arise during use, tapering, or discontinuation, including benzodiazepine-induced neurological dysfunction or binding.
While not everyone experiences binding, experts agree that with a well-planned tapering strategy, side effects can be lessened.
Dr. Carl Zalzman, a psychiatry professor at Harvard Medical School and former president of the American Psychiatry Association’s Benzodiazepine Task Force, commented on the issue.
Despite their existence since the 1960s, many healthcare providers are still at a loss regarding how to help patients discontinue these medications effectively. There is no one-size-fits-all tapering strategy. Some patients experience withdrawal symptoms, and others require continued access to medications while tapering slow.
Dr. Silverman recalled a patient who had to meticulously slice pills with a razor blade to gradually decrease dosage and mitigate severe side effects.
The new guidelines from ASAM, which address the limited studies available on effective tapering, mainly rely on clinical experience. They advise clinicians to review the risks and benefits of benzodiazepine prescriptions at least every three months, recommending a dosage reduction of 5-10% every 2-4 weeks. The guidelines stress that long-term users may need to taper for over a year and should be monitored post-discontinuation.
“Most of us were never informed of the potential for dependency and long-term complications,” said De Foster, an advocate for those suffering from benzodiazepine complications, who contributed to the new guidelines. He emphasized, “A slow taper can be challenging, but a sudden withdrawal is perilous.”
ASAM’s guidance came too late for Ratasha Marberry, 49, a New York resident who became physically dependent on Klonopin. In 2022, she entered an addiction detox center, desperate to stop the medication she had been prescribed for insomnia. The facility’s provider took her off the medication in just five days.
She shared that it felt like collapsing as she faced nights filled with turmoil akin to “a lion in the room that you can’t see but are fighting against.” She later visited another facility in Florida where she was prescribed antidepressants. Within weeks, she began to feel a significant improvement.
Now she states, “I’m sleeping like a strange baby.”
She reflects, “Should I have been prescribed this drug for an extended period rather than a benzodiazepine?”
“When I think back to my experiences, I cry,” she confessed. “It wasn’t physical pain, but rather emotional suffering. I’m thankful to be alive.”
If you are in crisis or contemplating suicide, reach out to 988 for the National Suicide Prevention Lifeline; visit Speaking of Suicide for additional resources.
Source: www.nytimes.com
